Total knee arthroplasty in patients with severe obesity: outcomes of standard keeled tibial components versus stemmed universal base plates
1
조회
0
다운로드
0
인용
0
참고문헌
초록
Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m 2 ] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m 2 : standard keeled (SK) or universal base plate (UBP), which incorporates a stem. This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m 2 : mean age 62.2 ± 8.0 (44–87) years, mean BMI 44.3 ± 4.6 (40–65.7) kg/m 2 and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan–Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4–100 95% confidence interval (CI)] and UBP 100% ( p = 0.391). Overall varus alignment of the limb ( p = 0.005) or the tibial component ( p = 0.031) was significantly associated with revision and return to theatre. At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m 2 . Varus alignment of either tibial component or the limb was associated with revision and return to theatre.
Abstract
Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m 2 ] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m 2 : standard keeled (SK) or universal base plate (UBP), which incorporates a stem. This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m 2 : mean age 62.2 ± 8.0 (44–87) years, mean BMI 44.3 ± 4.6 (40–65.7) kg/m 2 and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan–Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4–100 95% confidence interval (CI)] and UBP 100% ( p = 0.391). Overall varus alignment of the limb ( p = 0.005) or the tibial component ( p = 0.031) was significantly associated with revision and return to theatre. At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m 2 . Varus alignment of either tibial component or the limb was associated with revision and return to theatre.
참고문헌 (31)
- Zheng H, "Body mass index and risk of knee osteoarthritis : systematic review and meta-analysis of prospective studies", BMJ Open, 5, pp.e007568~ (2015)[DOI]
- Weir CB, "BMI classification percentile and cut off points", StatPearls, ~ (2019)
- Kerkhoffs GMMJ, "The influence of obesity on the complication rate and outcome of total knee arthroplasty : a meta-analysis and systematic literature review", J Bone Jt Surg, 94, pp.1839~1844 (2012)[DOI]
- Elcock KL, "Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications", Bone Joint J, 104-B, pp.452~463 (2022)[DOI]
- Spicer D, "Body mass index as a predictor of outcome in total knee replacement", Int Orthop, 25, pp.246~249 (2001)[DOI]
- Postler A, "Analysis of total knee arthroplasty revision causes", BMC Musculoskelet Disord, 19, pp.55~ (2018)[DOI]
- Sharkey PF, "Why are total knee arthroplasties failing today—has anything changed after 10 years?", J Arthroplasty, 29, pp.1774~1778 (2014)[DOI]
- Le DH, "Current modes of failure in TKA : infection, instability, and stiffness predominate", Clin Orthop Relat Res, 472, pp.2197~2200 (2014)[DOI]
- Scott CEH, "The role of the design of tibial components and stems in knee replacement", J Bone Joint Surg Br, 94-B, pp.1009~1015 (2012)[DOI]
- Abdel MP, "Increased aseptic tibial failures in patients with a BMI ≥ 35 and well-aligned total knee arthroplasties", J Arthroplasty, 30, pp.2181~2184 (2015)[DOI]
- Elzohairy MM, "A comparative prospective study between stemmed versus an unstemmed tibial component in total knee arthroplasty in obese patients", Eur J Orthop Surg Traumatol, 31, pp.695~703 (2021)[DOI]
- Schultz BJ, "The use of stems for morbid obesity in total knee arthroplasty", J Knee Surg, 32, pp.607~610 (2019)[DOI]
- Garceau SP, "Reduced aseptic loosening with fully cemented short-stemmed tibial components in primary cemented total knee arthroplasty", J Arthroplasty, 35, pp.1591~1594.e3 (2020)[DOI]
- Fournier G, "Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up", Knee Surg Sport Traumatol Arthrosc, 28, pp.3919~3925 (2020)[DOI]
- Completo A, "The influence of stem design on strains and micromotion in revision total knee arthroplasty : finite element analysis", III Eur Conf Comput Mech, 2008, pp.182~182 (2006)
- Abraham R, "An anatomical study of tibial metaphyseal", diaphyseal mismatch during revision total knee arthroplasty, 2007, pp.22, 241~244
- Rabin R, "EQ-SD : a measure of health status from the EuroQol group", Ann Med, 33, pp.337~343 (2001)[DOI]
- Dawson J, "Questionnaire on the perceptions of patients about total knee replacement", J Bone Jt Surg, 80, pp.63~69 (1998)[DOI]
- Scott CEH, "Predicting dissatisfaction following total knee replacement", J Bone Joint Surg Br, 92-B, pp.1253~1258 (2010)[DOI]
- Beard DJ, "Meaningful changes for the Oxford hip and knee scores after joint replacement surgery", J Clin Epidemiol, 68, pp.73~79 (2015)[DOI]
- Charlson M, "Validation of a combined comorbidity index", J Clin Epidemiol, 47, pp.1245~1251 (1994)[DOI]
- Sarmah SS, "The radiological assessment of total and unicompartmental knee replacements", J Bone Joint Surg Br, 94-B, pp.1321~1329 (2012)[DOI]
- Morcos MW, "Outcomes of stemmed versus un-stemmed varus-valgus constrained components in primary total knee arthroplasty", Orthop Res Rev, 13, pp.9~13 (2021)[DOI]
- Parratte S, "Do stemmed tibial components in total knee arthroplasty improve outcomes in patients with obesity?", Clin Orthop Relat Res, 475, pp.137~145 (2017)[DOI]
- Steere JT, "Prophylactic tibial stem fixation in the obese : comparative early results in primary total knee arthroplasty", Knee Surg Relat Res, 30, pp.227~233 (2018)[DOI]
- Garceau SP, "Increased rates of tibial aseptic loosening in primary cemented total knee arthroplasty with a short native tibial stem design", J Am Acad Orthop Surg, 30, pp.e640~e648 (2022)[DOI]
- Scott CEH, "Five-year survivorship and patient-reported outcome of the Triathlon single-radius total knee arthroplasty", Knee Surgery, Sport Traumatol Arthrosc, 23, pp.1676~1683 (2015)[DOI]
- Scott CEH, "Excellent 10-year patient-reported outcomes and survival in a single-radius, cruciate-retaining total knee arthroplasty", Knee Surg Sport Traumatol Arthrosc, 27, pp.1106~1115 (2019)[DOI]
- Xu J-L, "Correlation between body mass index and periprosthetic joint infection following total joint arthroplasty", Medicine(Baltimore), 99, pp.e20549~ (2020)[DOI]
- Cox ZC, "Varus collapse in total knee arthroplasty : does fixation or bone fail first?", J Arthroplasty, 37, pp.162~167 (2022)[DOI]
- Gunst S, "The effect of obesity on mechanical failure after total knee arthroplasty", Ann Transl Med, 3, pp.310~ (2015)[DOI]